Want proof a 20% PPO discount off arbitrary billed charges is meaningless? Read on…..
A female patient initially admitted to an in-network hospital for an unspecified cough experienced severe complications, including sepsis, a nontraumatic subarachnoid hemorrhage, and cardiogenic shock. Additionally, minor surgery was required, leading to a total billed amount of $2,341,142.50. The PPO allowed amount of $1,872,530.66 (20% discount) set the baseline.
Upon the request of the third-party administrator (TPA), H.H.C. Group took on the challenge to further reduce the bill. Our dedicated team took a multi-faceted approach:
Thorough Examination: Nurse experts meticulously scrutinized the bill for potential errors.
Medical Review: Our Medical Director thoroughly examined the patient’s medical records.
Client Cooperation: The TPA secured approval for expedited funding from the group and stop-loss carrier.
Data-Driven Negotiation: Our attorney negotiator utilized both proprietary and published databases to determine fair pricing for the services provided and then engaged directly with the Chief Financial Officer at the hospital. After presenting all relevant information, the CFO agreed to accept $531,818.53 as payment in full, promptly sending the signed agreement the next day.
The total savings achieved amounted to $1,809,323.97, with a remarkable $1,340,712.23 below the PPO discounted amount.
This success underscores the value of our collaborative approach in navigating complex medical cases and achieving substantial savings for our clients.
Provider Type: Medical Center in the Western United States
Claim Type: In-Patient, In-Network
Admission Date: 6.3.2023
Discharge Date: 8.9.2023
Diagnosis: Initially admitted for an unspecified cough, the patient developed complications, including sepsis, nontraumatic subarachnoid hemorrhage, cardiogenic shock, and underwent a minor operation.
Bill Charged: $2,341,142.50
PPO Allowed Amount: $1,872,530.66 (20% discount)
H.H.C. Group Negotiated Amount: $531,818.53
Incremental Client Savings: $1,340,712.23
SOURCE: Team Effort Saves Incremental $1.3 Million on In-Network Claim – HHC Group
